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  • Writer's pictureAshleigh Richmond

Signs of Tethered Oral Tissue: Tongue, Lip and Buccal Ties

Updated: Nov 11, 2023

Let's talk about common signs and symptoms of tethered oral tissues. Tethered oral tissues (TOTs) is another name for tongue, lip and buccal ties. If you suspect TOTs in your baby, your first stop should be an IBCLC with specific training in tethered oral tissues AND oral rehabilitation. All of the IBCLCs at Wisco Lactation have these advanced trainings.

crying baby

Infant Issues:

  • Noisy suckling/clicking

  • Inability to latch to the breast

  • Popping on and off the breast

  • Leaking milk out of sides of mouth (breast or bottle)

  • Poor weight gain

  • Coughing or gagging

  • Lip Blisters

  • Gas Pain

  • Noisy breathing/snoring sounds when sleeping

  • Mouth breathing

  • Sleeping with mouth open

  • Reflux or colic symptoms

  • Chomping at the breast

  • Body tensions

Nursing Parent Issues:

  • Nipple shape change after feeding (creased, lipstick shaped, flattened)

  • Nipple Pain or Damage

  • Poor breast drainage

  • Decreased milk supply

  • Recurrent plugged ducts or mastitis

Babies with TOTs tend to have feeding issues at breast or bottle. Affected babies can sometimes learn to compensate to get what they need when eating, but those compensations can lead to bigger issues later in life. One worry is that milk supply may decrease as the baby gets older if the baby is not feeding functionally.

The procedure to release the tethered oral tissues is called a frenectomy. This severs and releases the tight frenum allowing it freedom of movement. Usually this is done with laser or scissors by a dentist, ENT or other medical professional. Choose your provider based on experience and results. Some medical professionals say that they can release the tissue but do not release completely and another procedure is necessary to alleviate symptoms. If your provider mentions that they are going to "snip" the tie - run the other way. They will likely only release the anterior portion of the tie. Your IBCLC will be able to guide you towards the best providers in your area.

Body tensions are a side effect of TOTs. This can be in baby's neck, shoulders, jaw or elsewhere in their body. The tongue is connected down to the toes through the deep front line. If the tongue is tight, most likely there is tightness elsewhere. We suggest bodywork such as chiropractic, craniosacral therapy, myofascial release or other modalities to help relieve the tension BEFORE seeing a release provider with continuation of therapy afterwards.

Our preferred TOTs treatment timeline:

  1. IBCLC full assessment including infant, parent and viewing a full feeding

  2. Referral for bodywork and begin oral exercises

  3. Follow up IBCLC assessment to assess for frenectomy readiness

  4. Continuation of IBCLC assessments until baby has achieved as much oral function and release of body tensions as possible

  5. Prep family for frenectomy aftercare

  6. Referral to frenectomy provider

  7. Post procedure follow up visits at 24 hours, 4 days and 7 days with IBCLC and/or Occupational Therapist to check wound healing and assess oral function

  8. Continued bodywork

  9. "Graduation" of baby from care when functional feeding is achieved

The goal is to achieve functional feeding to set your baby up for good oral function for a lifetime! Remember that when dealing with TOTs, it's a journey and not a magic fix.

Find a trained IBCLC in your here:

Many states have tongue tie groups on Facebook with lists of providers for that state. Search for "tongue and lip tie in (your state)" to find your local group.

Can't find someone local and need more help with TOTs? Book a visit with Wisco Lactation! We offer home & office visit in SE Wisconsin and NE Illinois. We also offer virtual visits worldwide.


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